Mental illness: two incorrect perspectives

The other day on e2 I read a writeup under seasonal affective disorder, by Doyle. It was a well written writeup with some good thoughts behind it. The basic message of this writeup seemed to be: to call something as natural as "getting the blues" a "disorder" seems to be a departure from common sense. I mention this node because it is one of the most recent and because it bears on my recent experience this winter. However, there are quite a few nodes similiar to this on e2. The basic message of this is that emotional states, even negative ones, are not "disorders", and should not be treated as some sort of clinical problem.

This, of course, is not an attitude confined to e2. Today I was at the Multnomah County Library and I came across a book entitled "Depression is a choice : winning the fight without drugs". There is actually an entire school of thought, it seems, that believes that depression is just a myth, a wildly overdiagnosed label used by the medical profession and drug industry to sell lots of drugs. A school of thought that believes that depression, along with other mental illnesses, can be beat with sheer willpower. Perhaps we would be better kicking all of the mentally ill off of social security and letting them go get jobs, which would probably immediatly perk them up, and enable them to live as happy, productive citizens.

On the other hand are people who believe that mental illness is strictly a matter of chemistry, a strictly determined biochemical phenomenon imprinted in our genes. According to this view, the only way to deal with mental illness (if it can be dealt with at all) is with drugs, and lots of them. In this view, lifestyle changes are totally irrelevant since they can't change the genetic information causing the problem.

In my view, and I do admit that there is no way am I an expert on the issue of mental illness at all, both of these views are wrong. Of course, anytime you take a spectrum of views, the two most extreme views are going to be (probably) wrong. To my way of thinking, the truth about mental illness lies somewhere between the two. Mental illness is neither "all in the head", nor is it a strict product of biochemical factors. I think that people who cling to the first view are stuck on an a priori view that people are naturally independent and autonomous, and that the mind is a Cartesian substance that can control its own functioning through pure logic and will. People who believe the second view have a problem that can best be summed up by paraphrasingSinead O'Connor: "First, all they know about is chemistry. Second, they don't know anything about chemistry." While serotonin may have entered our popular vocabulary, and the link between serotonin levels and depression is well established both in scientific thought and the popular mind, those who actually take the time to study the 2 dozen different serotonin receptor subtypes and their interlocking behavior, let alone all the other different types of receptors in the brain, would hardly say something as naive as "one type of neurotransmitter can directly affect mood all the time". On top of that, my common sense, if I can allude to something so common, would not tell me that a person with a history of sexual or physical abuse with financial problems, a lack of social support and the other such problems seen in depression's main problem was a slight fluctuation in catechol levels in a few cubic milimeters of brain tissue. Mental illness, to me, is something real, that can not be overcome by "wishing it away". However, being real does not mean "strictly tied to easily measurable physical phenomena".

This all relates to me on a personal level. This past fall I had a great drop in schoolwork, physical health and general quality of life. I tried to overcome it simply by setting my nose to the grindstone and muscling ahead, but it didn't work. If I had been a little less macho, I probably could have gone to the doctor and gotten a diagnosis for seasonal affective disorder. However, before it came to that, I got possession of a full spectrum light, and also begin volunteering quite a bit. I also got involved in a project that involved sociailizing with a lot of people who appreciated my unique abilities. And after several months of depression, I was feeling cheerful and energetic again, seemingly overnight. So I overcame my (admittedly softcore) depression not through willpower, but through a mixture of lifestyle changes and the possible clinical (if placebo based) effects of the full spectrum light.

There is a wide variety of distinct human behaviors, a subset of which are considered by societies or individuals unacceptable. Judging a person's behavior is reasonable, but passing those judgements onto that person may not be.

Psychology is the study of the mind and human behavior, and experimentation is its core method. Suppose you took two children who had never seen a large body of water; A and B. You repeatedly place A into a wading pool with other children who are all having fun and enjoying themselves. You repeatedly place B into the rushing water of a river and force his head underneath the waves, causing him to feel the instinctual terror of drowning. After 10 repetitions with each child over 2 months, you blindfold both children and take them to the shallow end of a swimming pool, then you take off the blindfolds and dump them in the water. One child is fine with it but the other is screaming and terrified. He screams because he associates being in water with being assaulted. We can say it is unreasonable for a child to scream when placed in a swimming pool easily enough, but the way in which he learned that behavior is a product of the natural and normal functioning of his mind.

Motivation is not exclusively volitional, nor is it exclusively predisposed by mental illness, its identity lies in a mixture of these and other factors. Relating to the mentally ill can be like befriending a porcupine. Do not blame the porcupine for having sharp quills, but do not impale yourself on them either. Recognize the separation between his intentions and his effects, try to be a little more accepting, but judge actions in their own right. If you do pass judgements on people, know they are predicated by your level of understanding and lifetimes are not easily understood.

Actually, post-Prozac mainstream biological psychiatry tends to maintain that depression is about the death of neurons in your "mammalian brain", so to speak. SSRIs like Prozac (which make your brain marinate in its available serotonin longer) don't work until a few weeks after beginning treatment, even though serotonin levels are immediately shot up. That is, SSRIs are stimulating neuron regrowth (yes, it's been observed in controlled lab settings).

More strongly, dr. Post's 1980 observation of the kindling phenomenon in bipolar disorder has led him to link manic-depressive illness to epilepsy -- which is why most drugs for epilepsy have either been approved or used extensively on an off-label basis in bipolar disorder. Most recently drug companies have seeked approval of atypical antipsychotics for bipolar disorder and academia has come up with an alternative, gene-based theory I don't really understand but which brings "chemical imbalances" back into the debate. Of course, the attentive between us have noticed that this alternate development has come exactly when the main anticonvulsants went generic, that is, lost their patents, so any smaller pharmaceutical company can make lamotrigine, topiramate, etc. You don't spend your shareholder dollars pushing Lamictal when cheaply available equivalents like Indian-produced Lamitor can be found.

As someone who suffers from bipolar disorder, I'm fond of the (older) convulsive hypothesis for bipolar disorder; temporal lobe epilepsy shares quite a few symptoms with us, and I'd very much like to be able to tell my boss that I have a form of epilepsy than keep the bald-faced lie that I suffer from strong, disabilitating fits of the migraines. So I'm not impartial on this. But I have deep suspicions that epilepsy, migraine and bipolar disorders are Three Buzzing Conditions

(Actually, some of the anticonvulsants we guys at bipolar disorder share have also been approved for migraines or only for migraines (like Topamax). For the longest while, until I was put on Seroquel as an add-on, I could credibly claim that all the drugs I was taking (Lamictal, Depakote, Topamax) were meant for those disabilitating migraines I don't have. Migraines can be detected in imaging tests as stronger blood vessal pressure, but the "reverse" evidence from drug efficacy suggests that electrical convulsions are behind the buzzing three conditions -- epilepsy, bipolar disorder and migraines.)